Heart failure treatment device and method

ABSTRACT

A method and apparatus for treating heart failure is configured to be placed about at least a portion of a patient&#39;s heart to apply a mild compressive force on the heart over a range of elastic deformation of the apparatus. The apparatus can be shifted to second range of deformation. In some embodiments, the apparatus is shifted to the second range of deformation by application of a stimulus or alteration of environmental conditions beyond a threshold level.

RELATED APPLICATIONS

This application claims priority to U.S. Provisional Application No.60/335,437, which was filed on Oct. 31, 2001, the entirety of which ishereby incorporated by reference.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to a device for treating heart failure.More specifically, the invention relates to a cardiac harness configuredto be fit around at least a portion of a patient's heart.

2. Description of the Related Art

Congestive heart failure (“CHF”) is characterized by the failure of theheart to pump blood at sufficient flow rates to meet the metabolicdemand of tissues, especially the demand for oxygen. One characteristicof CHF is remodeling of at least portions of a patient's heart.Remodeling involves physical changes to the size, shape and thickness ofthe heart wall. For example, a damaged left ventricle may have somelocalized thinning and stretching of a portion of the myocardium. Thethinned portion of the myocardium often is functionally impaired, andother portions of the myocardium attempt to compensate. As a result, theother portions of the myocardium may expand so that the stroke volume ofthe ventricle is maintained notwithstanding the impaired zone of themyocardium. Such expansion may cause the left ventricle to assume asomewhat spherical shape.

Cardiac remodeling often subjects the heart wall to increased walltension or stress, which further impairs the heart's functionalperformance. Often, the heart wall will dilate further in order tocompensate for the impairment caused by such increased stress. Thus, avicious cycle can result, in which dilation leads to further dilationand greater functional impairment.

Historically, congestive heart failure has been managed with a varietyof drugs. Devices have also been used to improve cardiac output. Forexample, left ventricular assist pumps help the heart to pump blood.Multi-chamber pacing has also been employed to optimally synchronize thebeating of the heart chambers to improve cardiac output. Variousskeletal muscles, such as the latissimus dorsi, have been used to assistventricular pumping. Researchers and cardiac surgeons have alsoexperimented with prosthetic “girdles” disposed around the heart. Onesuch design is a prosthetic “sock” or “jacket” that is wrapped aroundthe heart.

Although some of the above-discussed devices hold promise, there remainsa need in the art for a device for treating CHF to prevent a remodeledheart from further remodeling and/or help reverse remodeling of adiseased heart.

SUMMARY OF THE INVENTION

In accordance with one aspect of the present invention, an organreshaping device is provided. A reshaping member of the device iscomprised of elastic material, and is configured to be placed about atleast a portion of the organ such that the elastic material is subjectto substantially the same environmental conditions as the surface of theorgan. The elastic material has an elastic characteristic which: a)changes upon alteration of the environmental conditions beyond athreshold level; and b) remains at least partially changed upon returnof the environmental conditions from beyond the threshold level to anunaltered level.

In accordance with another embodiment, an organ reshaping device forexerting a force on an organ comprises a bending member configured to beplaced in contact with the organ so that the organ urges the bendingmember into a deformed shape relative to an at rest shape of the member,and the bending member exerts a bending force on the organ. The bendingmember has a first elastic deflection range and a second elasticdeflection range, and may operate over only one deflection range at atime. Further, the bending member is responsive to inputs to shiftbetween the first and second elastic deflection ranges.

In accordance with still another aspect of the invention, a method isprovided comprising providing a harness comprised of a shape memorymaterial and placing the harness around an organ while the shape memorymaterial is in a generally martensitic state. The method furtherincludes raising the temperature of the shape memory material totransform the shape memory material to a generally austenitic state sothat the harness generally hugs the surface of the organ.

In accordance with a further aspect, a method of reshaping an organ froman initial shape to a desired shape is provided. A reshaping harness isplaced about at least a portion of the organ, said placing comprisingelastically deforming the harness such that reshaping forces in responseto the deformation are applied by the harness to the organ within anelastic deflection range of the harness. The reshaping forces urge theorgan from the initial shape towards an intermediate shape between theinitial shape and the desired shape. After the organ has assumed theintermediate shape, the elastic deflection range of the harness isaltered so that the reshaping forces act within the altered deflectionrange to urge the organ from the intermediate shape towards the desiredshape.

In accordance with yet another aspect, the present invention provides anorgan shaping device for exerting a force on an organ. A bending memberis configured to be placed around at least a portion of the organ sothat the organ urges the bending member into an expanded deformed shaperelative to an at rest shape of the member, and the bending memberexerts a bending force on the organ that tends to squeeze the organ. Thebending member comprises a material configured to increase in stiffnessas the temperature of the material is increased within an operationalrange of temperatures.

In accordance with a further aspect, the material comprises a shapememory material.

In accordance with another aspect of the present invention, a methodcomprises providing a harness comprised of a shape memory materialhaving an at rest shape and placing the harness around an organ. Theplacing comprises expandingly deforming the harness from the at restshape so that the harness fits around at least a portion of the organand the harness applies a pressure onto the organ in resistance to thedeformation. The shape memory material is in a generally austeniticstate when at a temperature of the organ.

Further features and advantages of the present invention will becomeapparent to one of skill in the art in view of the Detailed Descriptionof Preferred Embodiments which follows, when considered together withthe attached drawings and claims.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a schematic view of a heart with cardiac harness placedthereon.

FIG. 2A-2B illustrate a spring hinge in a relaxed position and undertension.

FIG. 3 shows an embodiment of a cardiac harness that has been cut out ofa flat sheet of material.

FIG. 4 shows the cardiac harness of FIG. 3 formed into a shapeconfigured to fit about a heart.

FIG. 5A shows a portion of an embodiment of a cardiac harness disposedon a testing apparatus in a relaxed position.

FIG. 5B shows the portion of FIG. 5A in a stretched position.

FIG. 6A illustrates a stress/strain curve of a typical undulatingspring.

FIG. 6B illustrates a stress/strain curve of the cardiac harnessembodiment depicted in FIGS. 5A and B.

FIG. 7 shows a portion of another embodiment of a cardiac harness.

FIG. 8 shows a portion of another embodiment of a cardiac harness.

FIG. 9 shows the portion of FIG. 8 as viewed along line 9-9.

FIG. 10 shows the portion of FIG. 9 when pulled in tension.

FIG. 11 illustrates a stress/strain curve generally representative of atypical stainless steel material.

FIG. 12 illustrates another stress/strain curve generally representingthe behavior of a material and schematically demonstrating deflection ofa cardiac harness formed of the material.

FIG. 12A illustrates the stress/strain curve of FIG. 12 andschematically demonstrates another embodiment of deflection of a cardiacharness.

FIG. 13 shows an exemplary loading and unloading curve of Nitinol abovean austenite finish temperature.

FIG. 14 illustrates a stress/strain curve of thermally-induced Nitinol.

FIG. 15 illustrates a stress/strain curve of a thermally-induced Nitinoland depicts behavior of an embodiment of a cardiac harness takingadvantage of the properties of Nitinol.

FIG. 16 depicts a method and apparatus for injecting a warm fluidbetween a pericardium and heart wall.

FIG. 17 depicts a method and apparatus for electrically warming andadjusting a cardiac harness disposed on a heart.

FIG. 18 shows a series of curves representing test data for anembodiment of a cardiac harness.

FIG. 19 shows a curve representing test data for another embodiment of acardiac harness.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

As discussed in Applicants' co-pending application entitled “ExpandableCardiac Harness For Treating Congestive Heart Failure,” Ser. No.09/634,043, which was filed on Aug. 8, 2000, the entirety of which ishereby expressly incorporated by reference, it is anticipated thatremodeling of a diseased heart can be resisted or even reversed byalleviating the wall stresses in such a heart. The present applicationdiscusses certain embodiments, methods of manufacture, methods of use,and advantages of devices for reducing such cardiac wall stresses.Additional embodiments and aspects are also discussed in Applicants'co-pending application entitled “Device for Treating Heart Failure,”Ser. No. 10/242,016, which was filed on Sept. 10, 2002, the entirety ofwhich is hereby expressly incorporated by reference.

FIG. 1 illustrates a mammalian heart 30 having a cardiac wall stressreduction device in the form of a harness 32 applied to it. The cardiacharness 32 comprises a series of hinges or spring elements 34 thatcircumscribe the heart 30 and, collectively, apply a mild compressiveforce on the heart so as to alleviate wall stresses.

The term “cardiac harness” as used herein is a broad term that refers toa device fit onto a patient's heart to apply a compressive force on theheart during at least a portion of the cardiac cycle. Other devices thatare intended to be fit onto a heart and are referred to in the art as“girdles,” “socks,” “jackets,” or the like are included within themeaning of “cardiac harness.”

The cardiac harness 32 illustrated in FIG. 1 comprises at least oneundulating strand 36 comprising a series of spring elements 34 referredto as hinges or spring hinges that are configured to deform as the heart30 expands during filling. Each hinge 34 provides substantiallyunidirectional elasticity, in that it acts in one direction and does notprovide much elasticity in the direction perpendicular to thatdirection. For example, FIG. 2A shows one embodiment of a hinge member34 at rest. The hinge member 34 has a central portion 40 and a pair ofarms 42. As the arms are pulled, as shown in FIG. 2B, a bending moment44 is imposed on the central portion 40. The bending moment 44 urges thehinge member 34 back to its relaxed condition. Note that a typicalstrand comprises a series of such hinges, and that the hinges 34 areadapted to elastically expand and retract in the direction of the strand36.

In the embodiment illustrated in FIG. 1, the strands 36 of springelements 34 are constructed of extruded wire that is deformed to formthe spring elements. Although FIG. 1 shows adjacent strands 36interwoven one with another, it is to be understood that, in additionalembodiments, adjacent strands 36 may not overlay or touch one another.

FIGS. 3 and 4 illustrate another preferred embodiment of a cardiacharness 50, shown at two points during manufacture of such a harness. Inthe illustrated embodiment, the harness 50 is first formed from arelatively thin, flat sheet of material. Any method can be used to formthe harness. For example, in one embodiment, the harness isphotochemically etched from the material; in another embodiment, theharness is laser-cut from the thin sheet of material. The embodimentshown in FIGS. 3 and 4 has been etched from a thin sheet of Nitinol,which is a superelastic material that also exhibits shape memoryproperties. The flat sheet of material is draped over a form, die or thelike, and is formed to generally take on the shape of at least a portionof a heart.

With reference to FIGS. 1 and 4, the illustrated embodiments of thecardiac harnesses 32, 50 comprise a base portion 52, which is sized andconfigured to generally engage and fit onto a base region of a patient'sheart; an apex portion 56, which is sized and shaped so as to generallyengage and fit on an apex region of a patient's heart; and a medialportion 58 between the base and apex portions.

In the embodiment shown in FIGS. 3 and 4, the harness 50 comprisesstrands or rows 36 of undulating wire. As discussed above, theundulations comprise hinges/spring elements 34 which are elasticallybendable in a desired direction. Some of the strands 36 are connected toeach other by interconnecting elements 60. The interconnecting elements60 help maintain the position of the strands 36 relative to one another.Preferably the interconnecting elements 60 allow some relative movementbetween adjacent strands 36.

As discussed above, the undulating spring elements 34 exert a force inresistance to expansion of the heart 30. Collectively, the force exertedby the spring elements tends toward compressing the heart, thusalleviating wall stresses in the heart as the heart expands.Accordingly, the harness helps to decrease the workload of the heart,enabling the heart to more effectively pump blood through the patient'sbody and enabling the heart an opportunity to heal itself. It should beunderstood that several arrangements and configurations of springmembers can be used to create a mildly compressive force on the heart soas to reduce wall stresses. For example, spring members can be disposedover only a portion of the circumference of the heart or harness.

As can be appreciated, a variety of hinge/spring designs andarrangements can be used in embodiments of cardiac harnesses. FIGS. 5Aand B show a portion 62 of another embodiment of a cardiac harness 64disposed in a testing apparatus 66. The portion 62 is shown in a relaxedposition (FIG. 5A) and in a deformed, stretched position (FIG. 5B). Inthis embodiment, the cardiac harness 64 comprises a plurality of rows 36of undulating spring elements 34 that are connected one to another withangled interconnecting elements 68. Preferably, the interconnectingelements 68 are also capable of deflecting in a manner so as to act assprings. As can be seen in the figures, when an outside stress from thetesting apparatus 66 deforms the harness 64, both the undulating rows 36of springs 34 and the interconnecting elements 68 deform. In thismanner, the undulating rows 36 of springs can move relative to oneanother even though they are still connected via the interconnectingelements 68. However, the interconnecting elements 68 distributestresses between the rows 36.

The embodiment shown in FIGS. 5A and B also exhibits advantageousoverall deformation qualities. With next reference to FIG. 6A, astress/strain curve 69 of a typical undulating spring is shown. As canbe seen, as deformation (strain) increases, the corresponding stressalso increases. The embodiment of FIGS. 5A and B, however, has beenshown to exhibit stress/strain qualities more similar to that as shownin FIG. 6B. As illustrated, after application of an initial stress load70 to begin deformation, further deformation of the harness is achievedon a generally flat or low-slope stress plateau 72. The stress loadcorresponds to a force or pressure that will be exerted by the harnesson the heart. In operation, when initial deformation of the harness iscomplete, such as when it is fit about a patient's heart, the harnesswill operate in an elastic deformation range with a maximum stress valuethat is found on the stress plateau portion of the stress/strain curve.This is helpful for improving the safety of the device because theharness is designed so that the stress plateau 72 never exceeds certainstress levels during its working range of deformation. Accordingly, aharness having this configuration is designed so as to never exert apressure on the heart that is greater than a predetermined “safe”pressure level. For example, in one embodiment, a harness is configuredso that the plateau stress associated with deformation over the workingrange of the device corresponds to a compressive force exerted by thedevice, which compressive force never exceeds a predetermined upperlimit that may cause constriction of the heart.

With next reference to FIG. 7, another embodiment of a cardiac harness74 is illustrated wherein a right portion R of the harness is customizedfor the right side of the heart while a left portion L is customized forthe left side of the heart. Heart muscle fibers are known to contractand expand generally unidirectionally. Muscle fibers on the right sideof the heart follow a generally helical directional orientation in afirst direction, while fibers on the left side of the heart follow ageneral helical directional orientation in a second direction. In theembodiment illustrated in FIG. 7, undulating rows 36 are connected byinterconnecting elements 76, 78, but the interconnecting elements 76,78, are specially arranged to better cooperate with the directionalexpansion and contraction of the muscle fibers in the left and rightsides of the heart. More specifically, the interconnecting elements arearranged so as to be generally oblique to the direction of muscle fiberexpansion and contraction, and more preferably to be substantiallyperpendicular to the direction of expansion and contraction. Thus, inthe illustrated embodiment, the interconnecting elements 76 on the leftside L of the harness 74 extend in generally different directions thanthe interconnecting elements 78 on the right side R of the harness 74.In this manner, the unidirectionally-contracting muscle fibers can takeadvantage of the spring characteristics of both the undulating rows 36of springs 34 and the interconnecting elements 76, 78.

With reference next to FIGS. 8-10, a portion 80 of an additionalembodiment of a cardiac harness 82 is illustrated. More specifically,FIGS. 8-10 show a portion of a strand 36 of spring elements 34. In thisembodiment, the spring elements 34 are configured in a “keyhole”configuration. As shown in FIGS. 8 and 9, a width w of the springelements is greater than a thickness t thereof. Thus, an aspect ratio ofthe width w divided by the thickness t of the spring elements 34 isgreater than one. As shown in FIG. 9, when the strand 36 is in a relaxedstate, the spring elements 34 generally lie in a plane. With referenceto FIG. 10, when the strand 36 is stretched longitudinally, the springelements 34 exhibit out-of-plane deformation. Portions of the springelements jut inwardly toward the heart epicardium. In the illustratedembodiment, successive peaks 84 a-d and valleys 86 a-c of adjacentspring elements 34 jut in generally opposite directions.

In accordance with further embodiments, one, several or all strands of acardiac harness can have an aspect ratio configured such thatout-of-plane deformation occurs during extension of the strand. In suchembodiments, the inwardly-jutting portions are directed against theheart wall, increasing the friction between the harness and the heart.As such, the out-of-plane deformation helps anchor the harness to theheart. In a preferred embodiment, at least one strand of spring elementsat or adjacent the base of the harness is configured so that the springelements display out-of-plane deformation when the strand islongitudinally deformed. As such, anchoring forces are focused at ornear the base of the harness. In further embodiments, one or severalspring elements of a strand are configured to display such out-of-planedeformation.

In the embodiment illustrated in FIGS. 8-10, the aspect ratio is betweenabout 1.8-2.0. It is to be understood, however, that other ranges ofaspect ratios can be selected in order to obtain a magnitude ofout-of-plane deformation desirable to help anchor the harness to theheart. The embodiment illustrated in FIGS. 8-10 has a generallyrectangular cross-sectional shape. It is to be further understood thatspring elements having other cross-sectional shapes, such as oval, canalso display out-of-plane deformation.

During the cardiac cycle, cardiac wall stress is greatest at or near theend of diastole D_(F), when the left ventricle has been filled withblood to be pumped into the vasculature of the patient. Conversely, wallstress is lowest at the beginning of diastole D_(S), before theventricle has been filled. In accordance with embodiments described inmore detail below, a cardiac harness can be configured to take advantageof the properties of various materials in order to minimize the appliedforce at the beginning of diastole D_(S) and maximize the applied forceof the harness at or near the end of diastole D_(F).

With reference next to FIG. 11, a stress/strain curve 90 generallyrepresentative of a typical construction material, such as stainlesssteel, is provided. The illustrated curve shows the strain ε associatedwith particular applied stresses σ in the material's range of elasticdeformation. As can be seen, application of a specific stress σ deformsthe material, resulting in a characteristic percentage strain Γ of thematerial. When the stress σ is released, the material returns to itsat-rest condition 92.

The stress/strain characteristics of the material as illustrated in FIG.11 hold true when the material is used to construct a cardiac harnesssuch as a harness having structure similar to one or more of theembodiments discussed above. As discussed above, such a harness isspecially configured to be placed on a beating heart. Of course, thesize of the heart varies between the beginning of diastole D_(S) and theend of diastole D_(F). In the illustrated embodiment, the labels D_(S)and D_(F) have been applied to the stress/strain curve 90 to identifythe stress and strain conditions of the harness material associated withthe size of the heart (and harness) at the start and finish of diastoleD_(S), D_(F), respectively. Since the harness expands and contracts withthe beating heart, the harness can be expected to operate within adeflection range that includes D_(S) and D_(F).

As depicted in FIG. 11, the level of strain 6 is greater at the end ofdiastole D_(F) than at the beginning of diastole D_(S). As would beexpected, the level of stress a at the end of diastole D_(F) is alsogreater than at the beginning of diastole D_(S). As such, the stainlesssteel harness exerts a greater compression force at the end of diastoleD_(F) than at the beginning of diastole D_(S). In this manner, thegreatest wall stresses are alleviated by the greatest compressive forceof the cardiac harness, while lesser wall stresses are relieved by asignificantly lesser compressive force.

Although the embodiment depicted in FIG. 11 has been described inconnection with a stainless steel harness, it is to be understood that asomewhat similar stress/strain diagram can be expected for a variety ofmaterials, such as, for example, other metals, polymeric materials, andcomposites. As such, a wide variety of materials can be used to achievethe above-described benefits for a diseased heart.

With next reference to FIG. 12, another stress/strain curve 94 shows thebehavior of stainless steel when it is deformed beyond its elasticlimit. After plastic deformation has occurred, the material does notreturn to its original size, but it does recoil. A new elastic range 100is established between the point of greatest deformation 102 and a pointof maximum recoil 104. The material behaves in this newly establishedelastic range 100 substantially similarly as it behaves as discussedabove with reference to FIG. 11. The newly-established elastic range 100depicted in FIG. 12 also depicts a phenomenon often referred to as“hysteresis”, in which, due to factors such as internal friction, amaterial follows a slightly different curve when being unloaded 106 thanit does when being loaded 108. This type of behavior is common inmaterials, and is more pronounced in some materials than others.

The curve 94 of FIG. 12 can describe the behavior and stressesassociated with a stainless steel cardiac harness that is constructedwith a size and/or shape that is smaller than a patient's diseasedheart. As the harness is installed on the patient's heart, it isplastically deformed to fit about the heart so that the point ofgreatest deformation 102 of the harness substantially matches the sizeand shape of the heart at the end of diastole D_(F). In this manner, thestainless steel cardiac harness can be custom sized to fit the heart.

In the same manner as used in FIG. 11, the labels D_(S) and D_(F)identify the stress and strain associated with the size of the heart atthe start and finish of diastole D_(S), D_(F), respectively, as theharness expands and contracts with the beating heart. Also as discussedabove with reference to FIG. 11, the harness exerts a greatercompressive force at the end of diastole D_(F) than at the beginning ofdiastole D_(S). As such, the greatest cardiac wall stress relief isprovided at the end of diastole. During operation, the harness willexpand and contract only between the sizes associated with the beginningand end of diastole D_(S), D_(F). Thus, only a portion of the newelastic range 100 between D_(S) and D_(F) is traversed by the harnessmaterial. This portion is depicted in FIG. 12 as a diastolic elasticrange 110. As shown, due to the hysteresis phenomenon, the stress level111 associated with the strain at D_(S) is between the points 107, 109on the loading and unloading curves 106, 108 of the new elastic range100 of the deformed harness material.

Studies have indicated that relieving cardiac wall stress cansignificantly benefit a diseased heart, especially an enlarged heart. Aswall stress is relieved, the heart muscle is better able to rest. Also,the pumping load on the heart is decreased significantly. Reducing wallstress in an enlarged heart will help stop and may even reverseenlarging, or remodeling of the heart. In this manner, the cardiacharness can function as a reshaping member, or reshaping harness, tohelp reshape or reverse remodel, a diseased heart.

As a heart reverse remodels, the size of the heart will tend todecrease; thus, the size of the heart at the beginning and end ofdiastole will change. For instance, in FIG. 12, an embodiment ispresented wherein the enlarged heart whose size was originallyrepresented by D_(S) and D_(F) reverse remodels and becomes smaller. Thesize of the smaller, reverse remodeled heart at the beginning and end ofdiastole is represented by D′_(S) and D′_(F), respectively.

As illustrated in FIG. 12, even for the reverse remodeled heart, theharness material still exhibits its greatest stress at the end ofdiastole D′_(F), and thus the compressive force of the harness isgreatest at the end of diastole D′_(F). However, the magnitude of, theapplied compressive force of the harness at both the beginning and endof diastole D′_(S), D′_(F) of the reverse remodeled heart iscomparatively smaller than the magnitude of the compressive forceapplied to the heart before reverse remodeling (see D_(S), D_(F)). Infact, in the embodiment shown, at the beginning of diastole D′_(S) ofthe reverse-remodeled heart, there is substantially no force exerted bythe harness.

With continued application of a compressive force to relieve cardiacwall stresses, it is anticipated that the heart will continue to reverseremodel and become even smaller still. As such, the size of an evenfurther reverse remodeled heart at the beginning and end of diastole,represented in FIG. 12 as D″_(S) and D″_(F), is lesser still thanprevious measurements. In the illustrated embodiment, a compressiveforce is still exerted on the heart at the end of diastole D″_(F), butsubstantially no force is exerted on the heart at the beginning ofdiastole D″_(S). In fact, the heart no longer moves within the expansionrange of the harness at the beginning of diastole D″_(S). Thus, at thebeginning of diastole D″_(S), the heart is no longer within a deflectionrange of the harness wherein the harness exerts a positive compressiveforce on the heart.

With specific reference next to FIG. 12A, in accordance with anotherembodiment similar to the stainless steel cardiac harness of FIG. 12,rather than the harness being plastically deformed to substantiallymatch the size of a diseased heart at the end of diastole D_(F), thestainless steel harness can be stretched so that its point of maximumdeformation 112 corresponds to a size or strain greater than the size ofthe diseased heart at the end of diastole D_(F). In this embodiment, theharness is overstretched as it is installed on the heart. However, dueto elastic recoil, the relaxed state of the harness is still smallerthan the diseased heart. For example, and as shown, the harness stilloperates within an elastic recoil range 116 of the material such that asignificant compressive force is exerted on the heart so as to relievewall stresses. At the same time, however, the harness can be sized andarranged so that at the beginning of diastole D_(S), substantially lesscompressive force is exerted on the heart wall.

In the embodiments discussed above, the cardiac harness has been shownto facilitate reverse remodeling of a heart. However, as the heartreverse remodels, the magnitude of the compressive force exerted by theharness becomes less and less, as shown in FIG. 12. Accordingly, theabove embodiments may limit the extent a heart can reverse remodel.

In accordance with another embodiment, the cardiac harness can beconstructed of a shape memory/superelastic material, such as one of thefamily of nickel titanium alloys known as Nitinol. Such a harness can beconfigured so that it is easily adjustable and can be repeatedlytightened about a patient's heart as the heart becomes smaller as aresult of reverse remodeling. In this manner, the benefits of the mildcompressive force exerted by the harness can be achieved over a widerrange of heart sizes, and the degree of reverse remodeling of a heartwill not be limited by the elastic range of the harness.

Nitinol is a material having structural and mechanical characteristicsthat are particularly suitable for cardiac harness applications. Inorder to appreciate these characteristics and to better describeembodiments comprising Nitinol, a basic understanding of the behavior ofNitinol alloys is helpful.

Nitinol exhibits transformational superelasticity, which refers to theability of a material to reversibly transform a crystal structure uponthe application of stress so that the material can undergo large elasticdeformations without substantial plastic deformation. This type ofsuperelasticity is exhibited when one crystal structure of the materialtransforms into another crystal structure. In Nitinol, a first crystalstructure or phase is known as the austenitic phase, and a secondcrystal structure is known as the martensitic phase. In one state of thematerial, a Nitinol material is generally in a martensitic phase. Inanother state, a Nitinol material can be generally austenitic. Infurther states, a Nitinol material can be partially austenitic andpartialy martensitic.

As discussed above, the family of Nitinol materials comprises variousnickel titanium alloys. The alloys generally exhibit similar behaviors,although properties may vary somewhat between particular alloys. Oneproperty that is common among Nitinol alloys is that at relativelyhigher temperatures, Nitinol is at rest in the austenitic phase, and atrelatively lower temperatures, Nitinol is at rest in the martensiticphase. More specifically, at temperatures above an austenite finishtemperature A_(F), unstrained Nitinol can be expected to be in theaustenitic phase. The martensitic phase is not stable at suchtemperatures, and will automatically transform to the austenitic phasewhen the material exceeds an austenite finish temperature A_(F). Inpractice, martensite transitions to austenite as the martensite isheated. The transition from martensite to austenite begins at anaustenite start temperature A_(S.) At the austenite finish temperatureA_(F), the phase transformation is substantially complete, and relaxedNitinol is substantially completely in the austentic phase.

However, austenitic Nitinol can be transformed into martensitic Nitinol,even at temperatures above the finish temperature A_(F), by inducingstress to the material. FIG. 13 shows an exemplary loading and unloadingcurve 120, 122 of Nitinol above the austenite finish temperature A_(F).As discussed above, stable, relaxed Nitinol is in the austenitic phaseat such temperatures. As a stress is applied, the austenitic Nitinoldeforms elastically along a generally linear path 124 indicating itsrange of elastic deformation. At a critical yielding stress, theaustenite begins to transform into martensite. During thistransformation, the applied stress remains about the same, althoughthere is a constant increase in the deformation of the material. Thus,the Nitinol forms generally a loading plateau 130 until the entireaustenite phase transforms into the martensite phase. This condition ofNitinol is known as stress-induced martensite. After the transition fromaustenite to martensite is complete, the curve forms a generallylinearly increasing path 132 corresponding to the range of martensiticelastic deformation. The curve terminates at a point of maximum elasticdeformation 134.

As discussed above, martensite is unstable at temperatures above theaustenite finish temperature A_(F). When stress-induced martensite isunloaded, the material will automatically return to its austenitic phasealong the unloading curve 122. With continued reference to FIG. 13, whenthe material is unloaded, it will first follow a linear path 136 as themartensitic phase elastically unloads. Note that due to factors such asinternal friction, hysteresis occurs and there is not a substantialoverlap of the loading and unloading curves 120, 122. At a secondcritical stress 138, the martensite begins to transform to austenite. Ina manner similar to that observed during loading, themartensite-to-austenite transformation continues along a generally flatunloading plateau 140. When the martensite has completely transformed toaustenite, the austenite material is elastically unloaded along anothergenerally linear portion 142 of the unloading curve.

FIG. 14 depicts a stress/strain curve 150 of a Nitinol material that hasbeen annealed and then cooled to a temperature below a martensite finishtemperature M_(F). The austenitic phase is not stable at suchtemperatures. Austenitic Nitinol transforms into martensite as it iscooled through a range of temperatures. The transformation fromaustenite to martensite begins at a martensite start temperature M_(S)and is substantially complete at the martensite finish temperatureM_(F). This phase of Nitinol is known as thermally-induced martensiteand exhibits somewhat different behavior in response to applied stressesthan austenitic Nitinol. As the Nitinol is cooled, it takes on a unique“twinned” crystal arrangement characteristic of thermally-inducedmartensitic Nitinol.

With continued reference to FIG. 14, as thermally-induced martensite issubjected to stress, the martensite first elastically deforms along agenerally linear curve 152. At a critical stress value 154, the“twinned” arrangement of the martensitic crystals begins to bestraightened out (“detwinning”). During detwinning, the martensiticNitinol exhibits a generally flat loading plateau 156. Once the crystalstructure has been detwinned, the martensitic Nitinol exhibits anothersubstantially linear elastic deformation range 158. When the martensiteis unloaded, it recoils elastically. However, the detwinned arrangementis retained, and the martensite will not automatically transform backinto the twinned arrangement. Thus, as shown, the elastic recoil doesnot return along the loading curve 150 to the original size and shape ofthe thermally-induced Nitinol. Instead, the elastic recoil defines a newelastic range 160.

Once the martensite has been unloaded, it can be repeatedly elasticallyloaded and unloaded, but will remain within the new elastic deformationrange 160, as shown in FIG. 14. Even partially detwinnedthermally-induced martensite will not automatically transform back intoa fully twinned arrangement. For example, if thermally-inducedmartensite is deformed to the deformation size X as set out on theloading curve of FIG. 14, the martensite has been only partiallydetwinned. If the material is then unloaded, the martensite will recoil,but will not retwin. In fact, the Nitinol then has a new elastic rangeX′ within which the Nitinol material can be repeatedly elasticallyloaded 162 and unloaded 164.

As discussed above, martensite is unstable at temperatures above theaustenite finish temperature A_(F), and will automatically begin totransform into austenite if subjected to temperatures above theaustenite start temperature A_(S). If thermally-induced martensite isheated to a temperature above the austenite finish temperature A_(F),the martensite will spontaneously transform into austenite. However, ifthe material is under stress, or has been strained, it will behave likestress-induced martensite and will follow the generally flat unloadingplateau 122 depicted in FIG. 13. For example, with simultaneousreference to both FIGS. 13 and 14, if the thermally-induced martensitewhich has been deformed to the point X in FIG. 14 is warmed to atemperature above the austenite finish temperature A_(F), themartensitic material will transform into austenite and stress-inducedmartensite, and will begin to shrink from deformation size X towarddeformation size Y along the unloading curve 122 depicted in FIG. 13.If, when the material has shrunken from size X to size Y, the materialis then cooled to a temperature below the martensite finish temperatureM_(F), the Nitinol will return to the thermally-induced martensite phaseand behavior depicted in FIG. 14, and will maintain the deformation sizeY as an elastic limit as shown in FIG. 14. The Nitinol will also have anew elastic deformation range Y′ in which the material can be repeatedlyelastically loaded 166 and unloaded 168.

One way of controlling the shrinking of the Nitinol while at atemperature above the austenite transition temperature A_(F) is tointroduce an obstacle that prevents the Nitinol from shrinking beyond acertain size. For example, an obstacle may prevent the Nitinol devicefrom shrinking beyond size Y in FIG. 13. Thus, if thermally-inducedmartensite of the size depicted at size X in FIG. 14 is heated to atemperature above the austenite transition temperature A_(F) so that itfollows the unloading curve 122 of FIG. 13 and becomes smaller, thematerial will cease shrinking at size Y because of the obstacle. TheNitinol material can then be cooled to a temperature below themartensite transition temperature M_(F) so that the Nitinol is at size Yof FIG. 14, but is again in a thermally-induced martensite phase. Inthis manner, the elastic deformation range of thermally-inducedmartensite can be controllably shifted from a first range, such as X′,to a second range, such as Y′.

The transition temperatures A_(S), A_(F), M_(S), M_(F) discussed aboveare partly a function of the particular Nitinol alloy employed andpartly a function of the heat treatment to which the alloy is exposed.As such, through the use of known heat treatment methods, a Nitinolalloy can be customized to have austenite start and finish temperaturesA_(S), A_(F) and martensite start and finish tempratures M_(S), M_(F) asdesired for a particular Nitinol cardiac harness embodiment.

Further, throughout this specification, applicants employ a “functional”use of the transition temperatures A_(S), A_(F), M_(S), M_(F). Such afunctional use is based upon the observed behavior of the Nitinolmaterial in an embodiment of a cardiac harness rather than upon amolecular analysis of the material. For example, in this specificationthe functional austenite finish temperature A_(F) is the temperatureabout at which the material begins to exhibit properties and behavior ofsubstantially fully austenitic Nitinol. The functional austenite finishtemperature A_(F) does not necessarily require that 100% of the Nitinol,at a molecular level, is in the austenitic phase.

In a preferred embodiment, a cardiac harness is constructed of a Nitinolmaterial having an austenite finish temperature A_(F) above a normalhuman body temperature. Such a Nitinol material may be provided by usinga particular alloy of Nitinol and/or by appropriately heat treatingNitinol in a known manner. The Nitinol harness of this embodimentpreferably will be in a thermally-induced martensitic condition whileinside the human body.

The thermally-induced martensitic Nitinol harness is sized so that whenit is at rest it is substantially smaller than the diseased heart uponwhich it is to be placed. Additionally, the at rest size preferably issmaller than or about the same as a target heart size of the patient.

With next reference to FIG. 15, which includes a substantialreproduction of the thermally-induced martensite loading curve 150 ofFIG. 14, as the harness is installed on the patient's heart, it isdeformed generally along the expected deformation curve ofthermally-induced martensite. The harness is stretched to be larger thanthe diseased heart upon which it is placed. For example, the point ofgreatest deformation A of the harness is somewhat beyond the point atwhich the heart would maximally deform the harness at the end ofdiastole D_(F).

As can be seen in FIG. 15, when initially installed, the cardiac harnesswill have an elastic range as depicted by elastic range A′. As discussedabove, the harness will operate within a diastolic elastic range 170between the beginning and end of diastole D_(S), and D_(F). Thecompressive force associated with the stress 172 exerted by the harnessat the end of diastole D_(F) is substantially greater than thecompressive force associated with the stress 174 exerted by the harnessat the beginning of diastole D_(S).

As also discussed above, application of the mild compressive force willtend to help the diseased heart reverse remodel so that the size of theheart will decrease, and correspondingly the size of the heart at thebeginning and end of diastole decreases. In a similar manner asdiscussed in connection with FIG. 12 above, the labels D′_(S), D′_(F) inFIG. 15 represent the beginning and end of diastole of the reverseremodeled heart. As shown, when the heart has reverse remodeled, thecompressive force exerted by the harness within elastic range A′ at thebeginning and end of diastole D′_(S), D′_(F) is decreased relative tothe forces applied before reverse remodeling. The benefit provided bythe harness is thus reduced, and further reverse remodeling may slow orstall.

In the illustrated embodiment, the Nitinol harness can be adjusted so asto move from the elastic deformation range A′ to a new elasticdeformation range B′. To adjust the harness, the temperature of theharness is increased above the austensite finish temperature A_(F) ofthe Nitinol material. There are many ways to apply thermal energy toraise the temperature of a Nitinol reshaping harness. For example,application of electricity, warm liquids, etc., can raise thetemperature as desired.

With continued reference to FIG. 15, in one preferred embodiment, theharness is bathed in a warm saline or water solution in order to adjustthe harness from a first elastic range A′ to a second elastic range B′.The warm liquid is supplied at a temperature above the finishtemperature A_(F), but below a temperature that would harm the body ifthe body is exposed to the temperature for a short period of time. Thewarm bath heats the Nitinol harness to a temperature above the austenitefinish temperature A_(F). The martensitic material will no longer bestable, and the harness will automatically begin transforming into anaustenitic structure, exhibiting behavior as indicated on the unloadingcurve 122 of FIG. 13. The harness will shrink in size but willeventually be blocked from further shrinkage by the heart, which acts asan obstacle to prevent the harness from shrinking beyond the size of thereverse remodeled heart at about the end of diastole D′_(F).

The warm liquid will soon disperse or cool to body temperature, whichpreferably is below the martensite transition temperature M_(F). Thus,the Nitinol harness will resume its thermally-induced martensiticstructure and will again exhibit behavior along the curve 150 of FIG.15. However, the harness will have shrunk so as to fit snugly around theheart. The harness will have a maximum size as indicated at point B, andan elastic deformation range resembling range B′. As such, thecompressive force exerted by the harness at the end of diastole D′_(F)is at or above the level of force when the harness was initiallyinstalled in the patient. This level of compressive force is beneficialand will initiate further reverse remodeling of the heart.

As time passes and the heart further reverse remodels, the heart willbecome yet smaller still. Eventually, as happened previously when theharness was operating in elastic range A′, the size of the furtherreverse remodeled heart at the beginning and end of diastole (nowlabeled D″_(S), D″_(F)) will be such that the harness, when operating inelastic range B′, no longer helps the heart further reverse remodel. Ator near such time, the procedure described above, wherein the harness iswarmed to a temperature above the austenite finish temperature A_(F) sothat the harness shrinks to the current size of the heart, and thencools back below the martensite finish temperature M_(F), is repeated.The harness is again fit snugly about the heart and the elastic rangeshifts from range B′ to a new range C′.

As can be appreciated, the adjustment process can be repeated as oftenas desired or until the heart has reverse remodeled to a point at whichthe patient and clinician are satisfied with the results. This processcan also be controlled so that the heart reverse remodels to a targetheart size. The harness can be configured and manipulated to exertsubstantially no compressive force at the beginning of diastole when theheart has reached its target size.

As shown in FIG. 15, when the harness shifts between elastic ranges,such as when the harness shifts from elastic range A′ to elastic rangeB′, the range of stresses available within the elastic ranges A′, B′remain generally the same. However, the strain range, or deflectionrange, of the harness shifts. As such, in the new elastic range, theharness can provide the same or similar reshaping forces to the heart,but the size of the harness has changed. Thus, substantially similarreshaping forces can be applied to a progressively smaller-sized heart.

This principle is especially beneficial in improving the safety of theharness, because the maximum reshaping force of the ranges remainssubstantially the same over the working range of the harness, eventhough the size of the harness can change. As such, the harnesspreferably is sized and configured so that the maximum reshaping forcedoes not exceed a predetermined value during use of the device. Forexample, in one embodiment, a cardiac harness is sized and configuredrelative to the diseased heart to be treated so that the compressiveforce exerted by the harness on the heart will never exceed about 20mmHg. In another embodiment, the compressive force limit can be about15-17 mmHg.

The above-described harness embodiments are relatively easy to installand adjust. Minimally invasive methods can be used to install theNitinol harness around the heart. Additionally, the clinician need notworry excessively about deforming the harness unevenly or sizing theharness imprecisely when installing the apparatus around the heart. Thisis because even if the apparatus is somewhat larger than the heart, theapparatus will operate in a range of elasticity which will include thesize and shape of the heart. Besides, the harness can be easily adjustedat any time as discussed above so as to fit snugly around the heart.

In an additional embodiment, during installation, the clinicianstretches the harness during installation so that the harness it islarger than the heart. This allows the clinician to install the harnessminimally invasively and with relatively little need to avoid deformingthe harness to be larger than the heart. After the harness is wrapped,perhaps loosely, around the heart, the clinician bathes the heart andharness in a warm liquid having a temperature above the austenite finishtemperature A_(F) of the harness. In a manner as described above, theharness will shrink to substantially conform to the size and shape ofthe heart. As the liquid cools to body temperature, the harness againcools to a thermally-induced martensite structure and operates in ananticipated elastic range. As such, the clinician needs only very littleprecision in installing the harness over the heart, yet the harness willbe shaped to match and hug the heart once installed.

In a further additional embodiment of a method for installing and usingembodiments of the harness, after installation of the harness on thepatient's heart, the patient's pericardium is substantially closed bythe clinician. With the pericardium substantially closed, the heart canbe bathed in a warm saline or water solution by simply injecting thewarm liquid into the space between the pericardium and the heart. Thewarm liquid will be held in that space, and thus will be able tosubstantially evenly heat the harness to a temperature above theaustenite finish temperature A_(F). The clinician may allow the warmliquid to cool and then naturally disperse from the pericardium, or theclinician can suck the warm liquid out of the pericardium by using thesame medium used to deliver the liquid. Even if the pericardium is notsubstantially closed by the clinician, the heart and harness still canbe bathed in warm water in order to heat the harness as desired.

As discussed above, the process of warming the harness so that itadjusts itself snugly about the patient's heart can be repeatedlyperformed in order to accommodate and encourage reverse remodeling.Preferably, the repeated adjustments are performed by injecting warmliquid between the closed pericardium and the heart, as just discussed.This operation can be conveniently and safely performed by a surgicalprocedure such as a procedure similar to the well knownpericardiocentesis procedure.

With next reference to FIG. 16, a procedure for warming the harness isillustrated schematically. A clinician employs an apparatus 180 having aneedle-like tip 182 to penetrate the patient's tissue, including thepericardium 184. The open distal end 186 of the tip 182 is arrangedbetween the pericardium 184 and the heart 30 outer wall. A source ofwarm fluid, such as a syringe 190, communicates with the needle 182through a tube 192, and warm fluid 194 is supplied from the source 190into the space between the pericardium 184 and the heart 30. After thefluid 194 has warmed the harness 32 in order to adjust the size of theharness, the clinician draws back the syringe 190 to retract at leastsome of the fluid. Alternatively, the fluid may be left in place to benaturally disposed of by the body. This exercise may be carried out onceor, to ensure coverage of substantially the entire harness, warm fluidcan be introduce at several points about the heart.

With next reference to FIG. 17, another embodiment of a method andapparatus 200 for warming and adjusting the harness is illustrated. Inthe illustrated embodiment, at least two wire leads 202 are connected tothe harness 32. An internal controller 204 is placed within thepatient's body and controls the flow of electricity to the leads 202. Anexternal radio controller 206 can be used to actuate and energize theinternal controller 204. In accordance with one embodiment, applicationof a voltage difference between the wire leads 202 will create a currentthrough the harness 32, which current warms the harness to a desiredtemperature sufficient to urge the harness to adjust. The voltagepreferably is chosen to not significantly interrupt the electricalstimulation of the heart's own electrical system during pumping.

In the illustrated embodiment, two wire leads 202 are disposed on theharness 32, one near the base 52 of the harness and the other near theapex 56. In an additional embodiment, several wire leads are provided,and the internal controller selectively actuates the leads in accordancewith a control system so that only certain pairs of leads are actuatedat any one time. As such, the internal controller controls how theharness is adjusted on the heart. For instance, in one embodiment, leadsnear the base of the heart are actuated before leads near the apex. Assuch, the size of the harness 32 is adjusted from the base 52 towardsthe apex 56. This helps maintain the position of the harness upon theheart, because if the harness were made tighter about the apex than itis about the base, there may be an increased tendency for the harness tobe pulled toward the base, and the fit of the harness 32 on the heart 30may be compromised.

In embodiments discussed above, the behavior of the Nitinol cardiacharness has been depicted as movable between the curves of FIGS. 13 and15 in response to application of thermal energy. The discussedembodiments describe raising the temperature of the Nitinol above theaustenite finish temperature A_(F) to obtain behavior along the curve ofFIG. 13, and then lowering the temperature of the Nitinol below themartensite finish temperature M_(F) to obtain behavior along the curveof FIG. 15. In an additional embodiment, a thermally-induced martensitecardiac harness is adjusted by raising the temperature of the harnessabove the austenite start temperature A_(S), without necessarily raisingthe temperature above the finish temperature A_(F). In this manner, atleast some of the martensitic Nitinol transforms to austenite, and theharness will begin to adjust.

In a still further additional embodiment, a Nitinol cardiac harness isprovided having an austenite start temperature that is less than apatient's normal body temperature, about 37° C. As such, the harness ispartially austenitic during normal operation within a patient's body,and will exhibit characteristics of both austenite and thermally-inducedmartensite.

With next reference to FIG. 18, a series of curves 210, 212, 214represents test data for an embodiment of a Nitinol harness. Each curveplots a pressure exerted by the harness in response to a correspondingdeformation of the harness. Each of the three curves 210, 212, 214represents the deformation behavior of the harness at a specifiedtemperature T₁, T₂, T₃, respectively. As shown, each curve 210, 212, 214has a generally similar shape, and has a relatively low increase inpressure exerted over a relatively wide range of deformation. The curveshapes are attributable to the design of the harness and to thecharacteristics of the Nitinol material.

In FIG. 18, the curve 210 taken at the highest temperature T₁ exerts thegreatest magnitude of pressure. As discussed above, an increase intemperature above A_(S) prompts an increase in the proportion of Nitinolthat is austenitic. Austenitic Nitinol tends to be more resistant todeformation than martensitic Nitinol. Thus, since the proportion ofaustenite in the harness increases with increasing temperature, themagnitude of pressure applied by the harness with increasing temperaturealso increases. Accordingly, in a further embodiment, a Nitinol cardiacharness has austenite start and finish temperatures A_(S), A_(F),configured so that the proportion of austenite to martensite at apatient's body temperature is such that the harness applies a pressureto the heart within a desired therapeutic range.

An applied pressure within a therapeutic range is defined herein as apressure of sufficient magnitude that, when applied to an organ such asthe heart, results in a benefit to the organ. In one embodiment, thetherapeutic range for a cardiac harness is between about 5-20 mmHg. Morepreferably, the therapeutic pressure is about 7-15 mmHg.

In another embodiment of a Nitinol cardiac harness, the harness istreated to have an austenite start temperature A_(S) below roomtemperature, about 30-33° C. As such, the stiffening properties ofaustenite help the harness to hug the heart even if the harness andheart are exposed to relatively-low room temperatures during harnessinstallation. Of course, when installation is complete and the harnesswarms to the patient's body temperature, the proportion of austeniterises, and the pressure exerted by the harness will correspondinglyrise. In a still further embodiment, a harness having an A_(S) belowroom temperature has an austenite finish temperature A_(F) below bodytemperature so that the harness is substantially fully austenitic duringoperation. Alternatively, the A_(F) remains above body temperature sothat the harness remains at least partially martensitic.

With continued reference to FIG. 18, and in a manner as discussed abovewith reference to FIGS. 12-15, labels D_(S) and D_(F) have been appliedto illustrate the relative pressures applied by the harness at thebeginning and end of diastole. As also discussed above, as a heartreverse remodels, the size of the heart generally decreases, asindicated by D′_(S) and D′_(F). Further reverse remodeling isrepresented by D″_(S) and D″_(F). Although the pressure exerted by theharness at the end of diastole D_(F), D′_(F), D″_(F), may decrease asthe heart reverse remodels, the applied pressure remains within adesired therapeutic range. Thus, a cardiac harness is configured toadjust continuously with the heart as the heart changes in size andcontinuously provides a therapeutic applied pressure to a patient'sheart even when the patient's heart reverse remodels extensively.

With next reference to FIG. 19, a pressure versus percentage straincurve 216 is presented for an embodiment of a Nitinol cardiac harnesshaving an austenite finish temperature A_(F) lower than roomtemperature. In this embodiment, the harness is substantially fullyaustenitic before and during installation, although at least somestress-induced martensite may form during harness deformation. In amanner as discussed above, the labels D_(S), D_(F), D′_(S), and D′_(F)illustrate the relative pressures applied by the harness at thebeginning and end of diastole as the heart reverse remodels. In theillustrated embodiment, the cardiac harness adjusts continuously withthe heart as the heart changes in size, and also applies a therapeuticpressure to the heart even when the heart reverse remodels extensively.

In accordance with embodiments-discussed above, the cardiac harness isdeformed from an at-rest, unstretched size and shape to a stretchedconfiguration in order to be installed on a patient's heart and apply atherapeutic pressure thereon. In such embodiments, the harness can beextensively deformed from its at-rest size and shape. In accordance withone embodiment, the unstretched size of the harness is about 25-70% ofthe size of the enlarged heart to be treated. More preferably, the atrest size of the harness is about 30-50% of the size of the enlargedheart to be treated.

The principles discussed above can be applied to any number of otherembodiments. Such embodiments can comprise modifications of theembodiments discussed above or can comprise totally different products.More specifically, aspects of the cardiac harness embodiments discussedabove can be applied to other types of apparatus for reshaping organs.As such, various reshaping harnesses or reshaping devices can applyaspects of the above-discussed cardiac harness embodiments for otheruses and organs.

As a patient's heart enlarges during congestive heart failure, theannulus of certain valves, such as the mitral valve, tends to grow withthe heart. Eventually, the valve annulus may increase in size to a pointat which the leaflets are not large enough to completely close thevalve. Another factor contributing to valve dysfunction is that as theheart enlarges, the geometry of the heart changes somewhat. Portions ofthe heart such as the papillary muscles are moved outwardly from theleaflets to which the papillary muscles are attached via the chordaetendinaea. These papillary muscles may be stretched to their limit sothat they prevent the valve leaflets from adequately approximating eachother. As such, the leaflets will not be able to fully close, and thevalve will leak; such valve leakage simply makes the patient's heartproblems worse.

In accordance with another embodiment, a harness or collar comprisingone or more rows of undulating springs/hinges can be configured to exerta compressive force on specific portions of a heart so as to helpprevent or diminish valve dysfunction. For example, a collar-type devicecomprising one or more undulating hinges can be specially configured tofit around a region of the heart known as the AV groove. The AV grooveis generally adjacent the mitral and tricuspid valves of the heart. AnAV groove collar can be arranged and configured according to theprinciples discussed in this application so as to exert a compressiveforce that will tend to decrease the size of the valvular annuli and/orprevent enlargement of the valvular annuli beyond a desired size.

In another embodiment, a papillary muscle band can be provided,comprising a plurality of undulating springs/hinges specifically sizedand configured to be placed around the heart in the area of thepapillary muscles. As known in the art, the papillary muscles aregenerally midway between the AV groove and the apex of the heart. Thus,a papillary muscle band can. exert a compressive force to reduce thediameter of the heart at the level of the papillary muscles. This willhelp the papillary muscles become less stretched so that they do notprevent closure of the valve leaflets.

As discussed above, a cardiac harness applies a mild compressive forceon a patient's heart. It is anticipated that embodiments of an AV groovecollar and papillary muscle band will exert a more aggressivecompressive force than a typical cardiac harness. It is also anticipatedthat the AV groove collar and papillary muscle band can be usedindependent of one another or in conjunction with one another and eitherindependent of or in conjunction with a cardiac harness. For example, apapillary muscle band can be placed on the heart before or afterinstallation of a cardiac harness.

In still further embodiments, portions of a cardiac harness can beprovided with varying stiffness, and an AV groove collar and papillaryband can be incorporated into a cardiac harness so as to applyspecially-directed forces to the specific portions of the heart.

Embodiments of an AV groove collar and papillary muscle band can bemanufactured of Nitinol or other shape memory material. As such, thesedevices can be placed upon a heart without worrying about fitting thedevices too closely. Applying heat will then shrink the devices so thatthey fit snugly about the respective portions of the heart.Additionally, these devices can be adjusted after the initialinstallation so as to prolong the beneficial effect anticipated by suchdevices.

In accordance with still further embodiments, reshaping harnesses madeof material such as Nitinol can be used to change the shape or affectthe function of various organs within the body, and can be adjusted inplace so as to apply a reshaping force on those organs.

It is not uncommon for certain relatively obese patients to undergo aprocedure known as stomach stapling. In this procedure, the size of thestomach is reduced so as to correspondingly reduce the appetite and foodintake of the patient. In another embodiment having aspects of thepresent invention, a stomach harness or gastric band can be providedthat is configured to fit substantially around at least a portion of apatient's stomach. The harness applies a compressive force on thestomach so as to substantially restrict the size of the stomach. Thedevice can be installed relatively loosely around the stomach and thenbe heated briefly so as to shrink the device tightly about the stomach.The device will then exert a force on the stomach that will tend toreduce the stomach size and reduce the patient's appetite. Of course,this device can later be tightened again and again by repeatedlysupplying heat to the device.

Yet another advantageous embodiment of the device is used to treataneurysms in various regions of the body such as, for example, in thebrain, a ventricle, or the aorta. Such aneurysms often contain clottingblood or the like and it is not necessarily advantageous to completelyand suddenly reshape the aneurysm or return it to its original shape. Incontrast, it may be preferable to slowly urge the aneurysm back to itsoriginal and intended shape. A harness-type band can be installed aboutthe aneurysm and configured and adjusted to fit snugly over theaneurysm, while exerting a mild compressive force thereon. As timepasses, the aneurysm will be slowly reshaped. If necessary, thecompressive band can also be adjusted in a manner as described above. Assuch, a flexible Nitinol band can controllably and safely treat ananeurysm.

In still another embodiment, a Nitinol harness can be useful in retinalsurgery. It is common in retinal surgery to apply a scleral band orscleral buckle about a patient's eyeball at the completion of thesurgery. In one embodiment, a ring-shaped scleral band is preferablyconstructed of Nitinol having an austenite finish temperature A_(F)below normal body temperature. Thus, the band can be expanded to beeasily placed around the patient's eyeball, and will automaticallyconstrict to hold itself snugly on the eyeball. In another embodiment,the scleral band is constructed of Nitinol having an austenite finishtemperature A_(F) above human body temperature. Thus, a clinician candeform the band to fit it over the patient's eye and then can apply heatso that the band shrinks down to the size of the eye. After the bandcools to the thermally-induced martensite condition, it will exert amild compressive force on the eye, but will be still be relativelyflexible.

In still further embodiments, a Nitinol reshaping harness can be used inother applications such as, for example, compression bandages, whichhelp reduce swelling immediately after surgery.

Although the embodiments discussed above have been discussedspecifically in light of Nitinol, it is to be understood that variousother materials can be used for a cardiac harness and can employ some orall of the aspects discussed herein. For example, non-Nitinolsuperelastic and/or shape memory materials can exhibit properties andbehavior that is similar to, if not the same as, at least some of theaspects of Nitinol as discussed above. For example, other materialsexhibit transformational superlasticity. Some suitable cardiac harnessmaterials can include metals and polymers such as oligo(e-caprolactone), dimethacrylate, Elgiloy™, titanium and tantalum.

The devices in the above embodiments have been described as comprising aplurality of hinges or spring elements. It should be understood,however, that a variety of configurations and arrangements that allowthe harness to expand and contract would be acceptable. For example, inother embodiments, a harness-type device can be constructed ofexpandable, braided filaments. Such embodiments can be constructed of avariety of materials, but, if shape memory/superelastic materials suchas Nitinol are used, these devices can take advantage of the principlesand characteristics described above.

Although this invention has been disclosed in the context of certainpreferred embodiments and examples, it will be understood by thoseskilled in the art that the present invention extends beyond thespecifically disclosed embodiments to other alternative embodimentsand/or uses of the invention and obvious modifications and equivalentsthereof. In addition, while a number of variations of the invention havebeen shown and described in detail, other modifications, which arewithin the scope of this invention, will be readily apparent to those ofskill in the art based upon this disclosure. It is also contemplatedthat various combinations or subcombinations of the specific featuresand aspects of the embodiments may be made and still fall within thescope of the invention. Accordingly, it should be understood thatvarious features and aspects of the disclosed embodiments can becombined with or substituted for one another in order to form varyingmodes of the disclosed invention. Thus, it is intended that the scope ofthe present invention herein disclosed should not be limited by theparticular disclosed embodiments described above, but should bedetermined only by a fair reading of the claims that follow.

1-32. (Canceled)
 33. A cardiac harness for treating a heart, comprising:a cardiac harness having a premounted size; and the cardiac harnesspremounted size being about 25% to about 70% of the size of the heartprior to the harness being mounted on the heart.
 34. The cardiac harnessof claim 33, wherein the cardiac harness premounted size is an at-rest,unstretched configuration.
 35. The cardiac harness of claim 34, whereinat least a portion of the cardiac harness is formed from Nitinol. 36.The cardiac harness of claim 35, wherein the cardiac harness iselastically deformed as it is being mounted on the heart.
 37. Thecardiac harness of claim 36, wherein the cardiac harness is configuredto apply continuous compressive force on the heart during both diastoleand systole.
 38. The cardiac harness of claim 37, wherein the cardiacharness applies a peak compressive force on the heart in the range ofabout 5 mm Hg to about 20 mm Hg.
 39. The cardiac harness of claim 33,wherein the cardiac harness is configured for minimally invasivedelivery.
 40. The cardiac harness of claim 39, wherein the cardiacharness is elastically deformed as the harness is mounted on the heartso that the harness automatically applies a compressive force on theheart.
 41. A cardiac harness for treating a diseased heart, comprising:a cardiac harness having a premounted size; the cardiac harnesspremounted size being about 25% to about 70% of the size of the heartprior to the harness being mounted on the heart; and the cardiac harnessbeing configured so that the harness is elastically deformed as theharness is mounted on the heart thereby automatically applying acompressive force on the heart.
 42. The cardiac harness of claim 41,wherein at least a portion of the cardiac harness is formed fromNitinol.
 43. The cardiac harness of claim 42, wherein the Nitinolmaterial is in a thermally-induced martensitic phase.
 44. The cardiacharness of claim 41, wherein the cardiac harness applies a peakcompressive force on the heart in a range of about 5 mm Hg to about 20mm Hg.
 45. The cardiac harness of claim 44, wherein the compressiveforce exerted by the cardiac harness at the end of diastole D_(F) isgreater than the compressive force exerted by the harness at thebeginning of diastole D_(S).
 46. The cardiac harness of claim 41,wherein the cardiac harness is configured for minimally invasivedelivery.